Outcomes and Discard of Kidneys From Pediatric Donors After Cardiac Death

Dagher, Nabil N.; Lonze, Bonnie E.; Singer, Andrew L.; Simpkins, Christopher E.; Desai, Niraj M.; Montgomery, Robert A.; Segev, Dorry L.

doi:10.1097/tp.0b013e31820cfd27

Cited by 5 publications

(7 citation statements)

References 40 publications

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“…Nine hundred one kidney transplants were reported in 11 retrospective studies (39,40,58,60,83,91,(94)(95)(96)(97)99), with the majority of the sample from three database reviews (39,40,83) and one case series (60). Delayed graft function ranged from 23% to 48% (40,58,83,99) and is significantly higher when compared with NDD kidneys. Graft survival ranged from 92.4% to 100% (32)(33)(34) at 1 year, 71% (39) to 85.6% (40) at 3 years, and 80.7% at 5 years (40).…”

Section: Allocation Of Organs Procured By Pdcddmentioning

confidence: 96%

“…Delayed graft function ranged from 23% to 48% (40,58,83,99) and is significantly higher when compared with NDD kidneys. Graft survival ranged from 92.4% to 100% (32)(33)(34) at 1 year, 71% (39) to 85.6% (40) at 3 years, and 80.7% at 5 years (40). Recipient survival ranged from 100% at 1 year (58,99) to 93% at 3 years (39).…”

Section: Allocation Of Organs Procured By Pdcddmentioning

confidence: 97%

See 1 more Smart Citation

Pediatric Donation After Circulatory Determination of Death

Weiss

Hornby

Witteman

et al. 2016

Pediatric Critical Care Medicine

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Section: Allocation Of Organs Procured By Pdcddmentioning

confidence: 96%

Section: Allocation Of Organs Procured By Pdcddmentioning

confidence: 97%

Pediatric Donation After Circulatory Determination of Death

Weiss

Hornby

Witteman

et al. 2016

Pediatric Critical Care Medicine

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“…Three concerns regarding pediatric DCD donors are relevant (71): uncertainty about the potential for recovery of meaningful brain function in children, making decisions about WLST difficult; concerns over consent because children are less likely to have expressed a personal preference on donation; and insufficient scientific data on the duration of asystole required before organ recovery. Nevertheless, results from pediatric DCD renal transplants are acceptable (72,73).…”

Section: Increased Use Of Pediatric Dcd Organs Transplanted To Adult mentioning

confidence: 97%

Donation After Circulatory Death

2014

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Organ donation after circulatory death (DCD) has been endorsed by the World Health Organization and is practiced worldwide. This overview examines current DCD practices, identifies problems and challenges, and suggests clinical strategies for possible improvement. Although there is uniform agreement on DCD donor candidacy (ventilator-dependent individuals with nonrecoverable or irreversible neurologic injury not meeting brain death criteria), there are variations in all aspects of DCD practice. Utilization of DCD organs is limited by hypoxia, hypotension, reduced--then absent--organ perfusion, and ischemia/reperfusion syndrome. Nevertheless, DCD kidneys exhibit comparable function and survival to donors with brain death kidneys, although they have higher rates of primary graft nonfunction, delayed graft function, discard, and retrieval associated injury. Concern over ischemic organ injury underscores the reluctance to recover extrarenal DCD organs since lack of medical therapy to support inadequate allograft function limits their acceptability. Nevertheless, limited results with DCD pancreas, liver, and lung allografts (but not heart) are now approaching that of donors with brain death organs. Pretransplant machine perfusion of DCD kidneys (vs. static storage) may reduce delayed graft function but has no effect on long-term organ function and survival. Normothermic regional perfusion used during DCD abdominal organ retrieval may reduce ischemic organ injury and increase the number of usable organs, although critical confirmative studies have yet to be done. Minor increases in usable DCD kidneys could accrue from increased use of pediatric DCD kidneys and from selective use of DCD/ECD kidneys, whereas a modest increase could result through utilization of donors declared dead beyond 1 hr from withdrawal of life support therapy. A significant increase in transplantable kidneys could be achieved by extension of the concept of living kidney donation in relation to imminent death of potential DCD donors. Progress in research to identify, prevent, and repair DCD-associated organ retrieval injury should improve utilization of DCD organs. Recent results using ex situ pretransplant organ perfusion of DCD organs has been encouraging in this regard.

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“…Organ Procurement and Transplantation Network/U.S. Scientific Registry of Transplant Recipients) 2012 annual data, kidney transplantation from DCD donors increased in 2011 [16], but represents less than 10 % of all transplanted pediatric kidneys [27,28]. A higher number of kidneys obtained by DCD are discarded compared to DBD, although neither an increase in delayed graft function nor graft loss has been observed in DCD [27].…”

Section: Pediatric Organ Donors and Their Managementmentioning

confidence: 99%

“…Scientific Registry of Transplant Recipients) 2012 annual data, kidney transplantation from DCD donors increased in 2011 [16], but represents less than 10 % of all transplanted pediatric kidneys [27,28]. A higher number of kidneys obtained by DCD are discarded compared to DBD, although neither an increase in delayed graft function nor graft loss has been observed in DCD [27]. For pediatric DCD kidney transplantation, the American Academy of Pediatrics recommends a period of 2-5 min before certification of death following the withdrawal of life support and the development of cardio-circulatory arrest, apnea and unresponsiveness [29].…”

Section: Pediatric Organ Donors and Their Managementmentioning

confidence: 99%

Strategies to optimize kidney recovery and preservation in transplantation: specific aspects in pediatric transplantation

et al. 2014

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In renal transplantation, live donor kidney grafts are associated with optimum success rates due to the shorter period of ischemia during the surgical procedure. The current shortage of donor organs for adult patients has caused a shift towards deceased donors, often with co-morbidity factors, whose organs are more sensitive to ischemia-reperfusion injury, which is unavoidable during transplantation. Donor management is pivotal to kidney graft survival through the control of the ischemiareperfusion sequence, which is known to stimulate numerous deleterious or regenerative pathways. Although the key role of endothelial cells has been established, the complexity of the injury, associated with stimulation of different cell signaling pathways, such as unfolded protein response and cell death, prevents the definition of a unique therapeutic target. Preclinical transplant models in large animals are necessary to establish relationships and kinetics and have already contributed to the improvement of organ preservation. Therapeutic strategies using mesenchymal stem cells to induce allograft tolerance are promising advances in the treatment of the pediatric recipient in terms of reducing/withdrawing immunosuppressive therapy. In this review we focus on the different donor management strategies in kidney graft conditioning and on graft preservation consequences by highlighting the role of endothelial cells. We also propose strategies for preventing ischemia-reperfusion, such as cell therapy.

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Outcomes and Discard of Kidneys From Pediatric Donors After Cardiac Death

Cited by 5 publications

References 40 publications

Pediatric Donation After Circulatory Determination of Death

Pediatric Donation After Circulatory Determination of Death

Donation After Circulatory Death

Strategies to optimize kidney recovery and preservation in transplantation: specific aspects in pediatric transplantation

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